Copyright 2007 Partners Radiology Patient Safety Training “Patient Safety in Radiology” Partners...

Copyright 2007 Partners Radiology

Patient Safety TrainingPatient Safety Training

““Patient Safety in Radiology”Patient Safety in Radiology”

Partners Radiology Patient Safety TeamPartners Radiology Patient Safety Team


GoalGoal

““Improve patient safety by providing Improve patient safety by providing staff with education about key staff with education about key

components of patient safety and to components of patient safety and to assess staff competency in doing so”assess staff competency in doing so”


ObjectivesObjectives

At the end of the training the participant will At the end of the training the participant will be able to:be able to:

– Identify JCAHO required radiology patient Identify JCAHO required radiology patient safety practicessafety practices

– Identify effects patient safety on patient, Identify effects patient safety on patient, department and hospitaldepartment and hospital

– Define & deploy the National Patient Safety Define & deploy the National Patient Safety GoalsGoals


Target AudienceTarget Audience

All clinical and non-clinical personnel - All clinical and non-clinical personnel - Techs, Techs, MDs, RNs and Support MDs, RNs and Support StaffStaff


Topic 1Topic 1

Tracer MethodologyTracer Methodology


Topic 1Topic 1

JCAHO PastJCAHO Past

Scheduled hospital accreditation visitsScheduled hospital accreditation visitsReview of Policy ManualsReview of Policy ManualsTalking primarily with managersTalking primarily with managersVisiting some specialty UnitsVisiting some specialty UnitsMinimal Patient ContactMinimal Patient Contact


Topic 1Topic 1

JCAHO PresentJCAHO Present

Unannounced VisitsUnannounced VisitsTalking primarily to ground level staffTalking primarily to ground level staffTracer methodologyTracer methodologyFollowing a patient’s trail throughout the Following a patient’s trail throughout the

hospitalhospitalTalking directly to patientsTalking directly to patientsAssure we are following our own policiesAssure we are following our own policies


Hazardous MaterialsHazardous Materials

Topic 2Topic 2


FlammableFlammableCorrosiveCorrosiveChemically reactiveChemically reactiveCompressed GasCompressed GasBiohazardBiohazard

DefinitionDefinition

Topic 2Topic 2


Material Safety Data SheetsMaterial Safety Data Sheets Know where to find themKnow where to find them All MSDS containAll MSDS contain

– Product informationProduct information– PPE informationPPE information– IngredientsIngredients– Health Hazard DataHealth Hazard Data– Disposal InformationDisposal Information– Fire and Explosion informationFire and Explosion information

MSDS SheetsMSDS Sheets

Topic 2Topic 2


Know who to callKnow who to callAlert coworkers in immediate areaAlert coworkers in immediate areaWear PPE defined on container or MSDSWear PPE defined on container or MSDSAvoid contact with skin and eyesAvoid contact with skin and eyesEvacuate the area if respiratory hazardEvacuate the area if respiratory hazardClose off and ventilate the areaClose off and ventilate the area

What to do if you have What to do if you have a chemical spilla chemical spill

Topic 2Topic 2


Fire SafetyFire Safety

Topic 3Topic 3


Common AcronymsCommon Acronyms

Topic 3Topic 3

R.A.C.ER.A.C.E..– Rescue Rescue – Activate AlarmActivate Alarm– Contain FireContain Fire– Extinguish/EvacuateExtinguish/Evacuate

P.A.S.S.P.A.S.S.– PullPull– AimAim– SqueezeSqueeze– SweepSweep


Fire ExtinguishersFire Extinguishers

Topic 3Topic 3

Contain dry chemicals for class A, B, and C Contain dry chemicals for class A, B, and C fires.fires.– Class A FiresClass A Fires

ordinary materials like burning paper, lumber, cardboard, ordinary materials like burning paper, lumber, cardboard, plastics etc.plastics etc.

– Class B FiresClass B Fires flammable or or combustible liquids such as gasoline, kerosene, liquids such as gasoline, kerosene,

and common and common organic solvents used in the laboratory. used in the laboratory.

– Class CClass C energized electrical equipment, such as appliances, switches, energized electrical equipment, such as appliances, switches,

panel boxes, power tools, panel boxes, power tools, hot plates and stirrers. and stirrers.


Shut off and unplug Shut off and unplug burning or smoking burning or smoking equipmentequipment

Shut off wall oxygen Shut off wall oxygen supply system after supply system after converting patients to converting patients to portable tanksportable tanks

Close doors and Close doors and windowswindows

Use ElevatorsUse Elevators Telephones except for Telephones except for

emergenciesemergencies Open Fire DoorsOpen Fire Doors Store anything within Store anything within

18 inches of a 18 inches of a sprinkler headsprinkler head

Topic 3Topic 3

DoDo Do NotDo Not


Topic 3Topic 3

Do you know?Do you know?

The location of your fire alarms?The location of your fire alarms?What number to call and what information What number to call and what information

to give the operator?to give the operator?The location of your fire extinguishers?The location of your fire extinguishers?Your evacuation route?Your evacuation route?How and when to evacuate?How and when to evacuate?


Topic 3Topic 3

Area of RefugeArea of Refuge

Usually exit stairwells are built to provide Usually exit stairwells are built to provide up to 2 hours of fire protectionup to 2 hours of fire protection


Infection ControlInfection Control

Topic 4Topic 4


Hand HygieneHand Hygiene Hand Hygiene is the easiest and most effective Hand Hygiene is the easiest and most effective

way to prevent the spread of Infection – Your way to prevent the spread of Infection – Your mother was right!mother was right!

Must be performed correctlyMust be performed correctly– Hands must be washed with soap and water in four Hands must be washed with soap and water in four

specific casesspecific cases Before eatingBefore eating After using the bathroomAfter using the bathroom When hands are visibly soiledWhen hands are visibly soiled After caring for a patient with C. Diff.After caring for a patient with C. Diff.

– Wash for as long as it takes to sing Happy Birthday Wash for as long as it takes to sing Happy Birthday twicetwice

Topic 4Topic 4


Hand HygieneHand Hygiene

– Cleanse the hands with an alcohol-based hand Cleanse the hands with an alcohol-based hand cleaner BEFORE and AFTER every contact cleaner BEFORE and AFTER every contact with the patient or the patient environmentwith the patient or the patient environment

– Use only approved hand lotion that is Use only approved hand lotion that is compatible with your particular cleanser twice a compatible with your particular cleanser twice a shift shift

– Do not wear artificial nails or nail jewelryDo not wear artificial nails or nail jewelry– Nails should be no more that ¼ inch long and Nails should be no more that ¼ inch long and

only polished with clear polishonly polished with clear polish

Topic 4Topic 4


PrecautionsPrecautions Universal or Standard PrecautionsUniversal or Standard Precautions

– Wear gloves, gown and/or mask whenever you might Wear gloves, gown and/or mask whenever you might be expected to be exposed to body fluidsbe expected to be exposed to body fluids

– Clean hands immediately after removing glovesClean hands immediately after removing gloves Contact Precautions – skin infections, Hep A, Contact Precautions – skin infections, Hep A,

chicken pox, E. colichicken pox, E. coli– Glove and Gown requiredGlove and Gown required– Isolate individual equipment like stethoscopes and BP Isolate individual equipment like stethoscopes and BP

cuffscuffs– Clean hands immediately after removing glovesClean hands immediately after removing gloves

Topic 4Topic 4


PrecautionsPrecautions

Contact Precautions Plus – C. DifficileContact Precautions Plus – C. Difficile– Gloves and Gowns required for careGloves and Gowns required for care– Spores are resistant to alcohol based cleanersSpores are resistant to alcohol based cleaners– Need to use soap and water after removing glovesNeed to use soap and water after removing gloves

Airborne Precautions – Measles, TB, chicken poxAirborne Precautions – Measles, TB, chicken pox– Negative Pressure roomNegative Pressure room– N95 TB maskN95 TB mask– Patient can be transported with regular surgical maskPatient can be transported with regular surgical mask

Topic 4Topic 4


PrecautionsPrecautions

Droplet Precautions – German measles, Droplet Precautions – German measles, meningitis, influenza, pneumonia, pertussismeningitis, influenza, pneumonia, pertussis– Need Private room or cohort with same illnessNeed Private room or cohort with same illness– Must wear a surgical mask within 3 feet of Must wear a surgical mask within 3 feet of

patientpatient– Patient must wear surgical mask for transportPatient must wear surgical mask for transport

Topic 4Topic 4


Safety Using MedicationsSafety Using Medications

Topic 5Topic 5


All medications must be securedAll medications must be secured– INCLUDES IV fluids and Contrast media!!INCLUDES IV fluids and Contrast media!!

Locked cabinets or Omnicell or Pyxis machinesLocked cabinets or Omnicell or Pyxis machines Stocked by trained personnelStocked by trained personnel

All Patients need documented assessment of All Patients need documented assessment of patient response after pain medicationpatient response after pain medication

All medication orders must be reviewed by All medication orders must be reviewed by a pharmacist before first dosea pharmacist before first dose

Topic 5Topic 5

Medication ManagementMedication Management


To ensure and accurate list of patient’s To ensure and accurate list of patient’s medications across the continuum of caremedications across the continuum of care– PAML – check meds on admissionPAML – check meds on admission– Any point of entryAny point of entry

Procedural patients full medication listingProcedural patients full medication listing At MGH, we check modality specific lists, like the Metformin At MGH, we check modality specific lists, like the Metformin

products that might interact with Contrastproducts that might interact with Contrast

Upon discharge, the list is again reconciled with Upon discharge, the list is again reconciled with the hospital records and the Outpatient/ PCP the hospital records and the Outpatient/ PCP recordsrecords

Topic 5Topic 5

Medication ReconciliationMedication Reconciliation


Critical Test ResultsCritical Test Results

Topic 6Topic 6


Goal 2A - For verbal or telephone orders or for Goal 2A - For verbal or telephone orders or for telephonic reporting of critical test results, verify telephonic reporting of critical test results, verify the complete order or test result by having the the complete order or test result by having the person receiving the order or test result "read -person receiving the order or test result "read -back" the complete order or test resultback" the complete order or test result

Goal 2C - Measure, assess and, if appropriate, take Goal 2C - Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and action to improve the timeliness of reporting, and the timeliness of receipt by the responsible the timeliness of receipt by the responsible licensed caregiver, of critical test results and licensed caregiver, of critical test results and valuesvalues

Topic 6Topic 6

Requirements for Goal Requirements for Goal 2A & 2C2A & 2C


Ineffective Communication is the most Ineffective Communication is the most frequent category of root causes of sentinel frequent category of root causes of sentinel eventsevents

Effective Communication, which is timely, Effective Communication, which is timely, accurate, complete, unambiguous and accurate, complete, unambiguous and understood by the recipient, reduces error understood by the recipient, reduces error and results in improved patient safetyand results in improved patient safety

Topic 6Topic 6

Rationale for Rationale for Requirement 2ARequirement 2A


The receiver of the information The receiver of the information writes writes down the complete order or test result or down the complete order or test result or enters it into a computerenters it into a computer

The receiver of the information The receiver of the information readsreads back back the order or test resultthe order or test result

The receiver of the information The receiver of the information receivesreceives confirmation from the individual who gave confirmation from the individual who gave the order or test resultthe order or test result

Topic 6Topic 6

Implementation for Implementation for Requirement 2ARequirement 2A


The organization defines critical tests and critical The organization defines critical tests and critical results/valuesresults/values

The organization defines the acceptable length of The organization defines the acceptable length of time between the ordering of critical tests and time between the ordering of critical tests and reporting the test valuesreporting the test values

The organization defines the acceptable length of The organization defines the acceptable length of time between the availability of critical time between the availability of critical results/values and receipt by the responsible results/values and receipt by the responsible licensed care giverlicensed care giver

Topic 6Topic 6

Implementation for Implementation for Requirement 2CRequirement 2C


The organization collects data on the timeliness of The organization collects data on the timeliness of reporting critical test results/valuesreporting critical test results/values

The organization assesses the data and determines The organization assesses the data and determines whether there is a need for improvementwhether there is a need for improvement

The organization takes appropriate action to The organization takes appropriate action to improve and measure effectiveness of those improve and measure effectiveness of those actionsactions

Topic 6Topic 6

Implementation for Implementation for Requirement 2CRequirement 2C


Emergency PreparednessEmergency Preparedness

Topic 7Topic 7


HEICS or HICSHEICS or HICS Hospital Emergency Incident Command has been Hospital Emergency Incident Command has been

recently revisedrecently revised The new name is HICS – Hospital Incident The new name is HICS – Hospital Incident

Command SystemCommand System The Incident Command Structure helps provide The Incident Command Structure helps provide

order instead of chaos for planned or unplanned order instead of chaos for planned or unplanned eventsevents

It is important for all employees to follow the It is important for all employees to follow the Chain of Command during an emergencyChain of Command during an emergency

Topic 7Topic 7


Sample Sample Hospital Incident Command Hospital Incident Command

StructureStructure

Topic 7Topic 7

S a fe ty/S e cu rity

P u b lic In fo O ffice r

M e d ica l O ffice r

L ia son O ffice r

H o sp ita l Inc id en t C om m an d er

L o g is tics P la nn ing F in an ce O p e ra tio ns

Radiology


Sample Radiology Incident Sample Radiology Incident Command StructureCommand Structure

Topic 7Topic 7

C lin ica l an d S u p po rt S ta ff

O p era tion s M a n ag e rs R a d io lo g is ts

R a d io lo g y U n it Le a d er

A n c illa ry S e rvice s D ire c to r

O p e ra tio n s C h ie f

H o sp ita l Inc id en t C om m an d er


Know the location of the Know the location of the department and hospital department and hospital Emergency Response Emergency Response plan.plan.

Know the location of the Know the location of the department telephone treedepartment telephone tree

Your role in a disasterYour role in a disaster Request needed supplies Request needed supplies

and staff through the chain and staff through the chain of command.of command.

Do not report to the Do not report to the hospital unless hospital unless specifically contacted.specifically contacted. Depending on the Depending on the situation you may be situation you may be needed for future shifts. needed for future shifts. All staff need to be All staff need to be accounted for. You must accounted for. You must check in with your chain check in with your chain of command when you of command when you arrive.arrive.

DoDo Do NotDo Not

Topic 7Topic 7


Are you prepared to help Are you prepared to help out during a disaster?out during a disaster?

Topic 7Topic 7

Disasters can strike at any time Disasters can strike at any time As healthcare workers we need to be prepared to As healthcare workers we need to be prepared to

respond in an organized and efficient manner respond in an organized and efficient manner Disasters can be of short or prolonged duration Disasters can be of short or prolonged duration Preparation in the workplace and in your home Preparation in the workplace and in your home

can insure that you will be ready to respond if can insure that you will be ready to respond if neededneeded


Family PreparednessFamily Preparedness

Topic 7Topic 7

Have a plan in place for your family in case Have a plan in place for your family in case you need to report to the hospital you need to report to the hospital

Make arrangements in advance for care of: Make arrangements in advance for care of: – Children Children – EldersElders– PetsPets


National Patient Safety GoalsNational Patient Safety Goals

Topic 8Topic 8


Use 2 patient identifiers (name & DOB or Use 2 patient identifiers (name & DOB or for newborn’s name & medical record #) for newborn’s name & medical record #) when providing carewhen providing care

Label all specimen containers in the Label all specimen containers in the presence of the patientpresence of the patient

Topic 8Topic 8

Improve the Accuracy of Improve the Accuracy of Patient IdentificationPatient Identification


Use Read-Back for verbal & telephone Use Read-Back for verbal & telephone orders or critical tests/values orders or critical tests/values

Write it Down - Read it back - Receive Write it Down - Read it back - Receive confirmationconfirmation

Write out the “dangerous 13” abbreviations Write out the “dangerous 13” abbreviations in all orders or medication documentationin all orders or medication documentation

Topic 8Topic 8Improve the Effectiveness Improve the Effectiveness

of Communication of Communication Among CaregiversAmong Caregivers


Measure and take action, if needed, to Measure and take action, if needed, to improve timeliness of reporting and receipt improve timeliness of reporting and receipt of critical test resultsof critical test results

Implement a standardized approach to Implement a standardized approach to "hand off" communications, include time "hand off" communications, include time for Q&Afor Q&A

Topic 8Topic 8Improve the Effectiveness Improve the Effectiveness

of Communication of Communication Among CaregiversAmong Caregivers


Standardize and limit the number of drug Standardize and limit the number of drug concentrations available in the organizationconcentrations available in the organization

Identify look-alike/sound-alike drugs used in Identify look-alike/sound-alike drugs used in the organization – prevent interchange errorsthe organization – prevent interchange errors

Topic 8Topic 8

Improve the Safety of Using Improve the Safety of Using MedicationsMedications


Label all medications, medication containers Label all medications, medication containers (e.g., syringes, medicine cups, basins) & (e.g., syringes, medicine cups, basins) & solutionssolutions

Label one at a time, 2 persons visually & Label one at a time, 2 persons visually & verbally verify if one prepares and another verbally verify if one prepares and another uses/givesuses/gives

Topic 8Topic 8

Improve the Safety of Using Improve the Safety of Using MedicationsMedications


CDC Hand Hygiene Guidelines:CDC Hand Hygiene Guidelines:– Before patient contact – hand sanitizer or soap and Before patient contact – hand sanitizer or soap and

waterwater After patient contact -After patient contact -

– Hands visibly dirty or “contact precautions +” – Use Hands visibly dirty or “contact precautions +” – Use soap and watersoap and water

– Hands not visibly dirty – Use hand sanitizer or soap Hands not visibly dirty – Use hand sanitizer or soap and waterand water

Perform a RCA on all deaths or permanent loss of Perform a RCA on all deaths or permanent loss of function related to healthcare associated infectionsfunction related to healthcare associated infections

Topic 8Topic 8

Reduce the Risk of Healthcare Reduce the Risk of Healthcare Associated Infections Associated Infections


Document a complete list of the patient's Document a complete list of the patient's current medications (home medication list)current medications (home medication list)

Compare & resolve discrepancies between Compare & resolve discrepancies between this list of medications to initial ordersthis list of medications to initial orders

On transfer of service and at discharge, On transfer of service and at discharge, reconcile new orders/prescriptions with reconcile new orders/prescriptions with home & current meds home & current meds

Topic 8Topic 8

Reconcile Medications Across Reconcile Medications Across the Continuum of Care the Continuum of Care


Communicate the list to the next provider at Communicate the list to the next provider at discharge or end of visitdischarge or end of visit

Provide the patient an inclusive list of Provide the patient an inclusive list of medications to take at discharge or end of medications to take at discharge or end of visitvisit

Topic 8Topic 8

Reconcile Medications Across Reconcile Medications Across the Continuum of Care the Continuum of Care


Fall reduction program – identify patients at Fall reduction program – identify patients at risk, teach patients and families to “Call…risk, teach patients and families to “Call…Don’t Fall”Don’t Fall”

Topic 8Topic 8

Reduce the Risk of Patient Reduce the Risk of Patient Harm Resulting from Falls Harm Resulting from Falls


Tell patients and their families how to Tell patients and their families how to report concerns about safetyreport concerns about safety

Topic 8Topic 8

Encourage Patients’ Active Encourage Patients’ Active Involvement in Their CareInvolvement in Their Care


Identify patients at risk for suicide, ensure Identify patients at risk for suicide, ensure safe setting and competent caresafe setting and competent care

Provide crisis hotline information to them Provide crisis hotline information to them and their families on discharge and their families on discharge

Topic 8Topic 8

Identify Safety Risks Inherent Identify Safety Risks Inherent in the Patient Populationin the Patient Population


Complete pre-operative / pre-procedure Complete pre-operative / pre-procedure verification processverification process

Mark the site so it is visible after prepping Mark the site so it is visible after prepping and draping (laterality, multiple structures, and draping (laterality, multiple structures, multiple levels)multiple levels)

Team “time out” immediately before the Team “time out” immediately before the procedureprocedure

Topic 8Topic 8

Universal Protocol: Ensure Universal Protocol: Ensure Correct Person ProceduresCorrect Person Procedures

Copyright 2007 Partners Radiology Patient Safety Training “Patient Safety in Radiology” Partners...

Documents

Transcript of Copyright 2007 Partners Radiology Patient Safety Training “Patient Safety in Radiology” Partners...